NC HealthConnex Dentrix Form - Smartlink Health Solutions

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NC HealthConnex Dentrix FormApril Koontz LCSW2024-01-19T16:12:06-05:00

Ready to connect to NC HealthConnex?

Just complete the form below.

Smartlink will then send you our Connection Agreement and Business Associate Agreement (BAA) for you to sign via Docusign.

First and Last Name *

Title *

Phone Number *

Email *

Please add nchealthconnex@smartlinkhealth.com to your email contacts.

Legal Practice Name *

City/County *

How many providers are in your practice? *

What type of insurance do you accept? *

These are the connections that SAS/NC HealthConnex is currently working on.

Were you previously connected to the HIE? *

Yes

Have you filed a Participation Agreement with NCHIEA? *

If no, please visit https://hiea.nc.gov/document-collection/forms

Yes, Submit Only

Yes, Full Participation

No, I have not filled out a Participation Agreement

Which EHR do you use? *

Thank you. You will receive an email from DocuSign shortly with our Connection Agreement and Business Associate Agreement (BAA). As soon as you complete these documents, someone from our implementation team will contact you to start working on your connection.

Ooops. Something went wrong. Please try again later.

First and Last Name *

Title *

Phone Number *

Email *

Please add nchealthconnex@smartlinkhealth.com to your email contacts.

Legal Practice Name *

City/County *

How many providers are in your practice? *

What type of insurance do you accept? *

These are the connections that SAS/NC HealthConnex is currently working on.

Were you previously connected to the HIE? *

Yes

Have you filed a Participation Agreement with NCHIEA? *

If no, please visit https://hiea.nc.gov/document-collection/forms

Yes, Submit Only

Yes, Full Participation

No, I have not filled out a Participation Agreement

Which EHR do you use? *

Ooops. Something went wrong. Please try again later.

Smartlink Health Solutions Headquarters

1000 Centre Green Way
Suite #250
Cary, NC 27513
Phone: 877-502-3067
Email: info@smartlinkhealth.com